From Daya (TBA) To Doctor: The Loss Of Compassion The

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Transcript From Daya (TBA) To Doctor: The Loss Of Compassion The

Family Planning
Dr. Amina Rashad
Maternity and Gynecology Nursing Dep.
Faculty of Nursing, Mansoura University
Specific objectives:

At the end of this chapter the student should be
able to
 Identify the concept of family planning.
 List types of family planning.
 Discuss mechanisms Of action of each method.
 Enumerate advantages and disadvantages of
each method .
 Explain side effects and complications of each
method.
 Provide health education about of each
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method.
Definition of family planning
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The WHO (1975) considered family planning as
practice that help individuals or couples to attain
certain objectives, which are:
1- Avoidance of unwanted birth.
2- Bringing about wanted birth.
3- Regulation of interval between pregnancies.
4- Avoid pregnancy for women with serious
disease that would place pregnancy at risk.
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TYPES OF FAMILY PLANNING
METHODS

1) Hormonal family planning methods:
 Oral contraceptives
 Injectable contraceptives
 Subdermal implants
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BARRIER METHODS
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Barrier methods of contraception include the
male condom,
female condom,
diaphragm,
cervical cap and spermicide.
All barrier methods are client-dependent.
To be effective, they need to be used correctly
and consistently with every act of sexual
intercourse.
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Mechanism of action
 These
methods work by physically or
chemically blocking the passage of
sperm. In addition, some methods
can prevent the transmission of
STDs between partners.
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Advantages of barrier methods

Effective at preventing pregnancy if used
consistently and correctly; however, some are
more effective than others

Condoms are effective in preventing STIS,
including HIV, if used consistently and
correctly

Safe
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 Have
no systemic side effects
 Easy to initiate and discontinue
 Immediate return to fertility
 Expect for the diaphragm and
cervical cap, barrier methods do not
require a clinic visit.
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Disadvantages of Barrier
methods
 Not
as effective as other modem
methods
 Some people find them difficult
to use consistently and correctly
 Some methods require partner’s
participation

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May
interrupt sexual activity
Need proper storage in order
to maintain the quality of the
products
Need re-supply
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LACTATIONAL AMENORRHEA
METHOD (LAM)

Def. The lactational amenorrhea method,
or LAM, is a temporary contraceptive
option for postpartum women.
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Who will use LAM

*Within 6 months postpartum
 *Amenorrheic

Fully or nearly fully
breastfeeding ( at least 85% of the
time )
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Mechanism of action
The stimulation of the nipples by infant’s suckling
sends nerve impulses to the mother’s
hypothalamus, causing the release of prolactin and
disruption in the release of gonadotrophinreleasing hormone (GnRH). The reduction in
GnRH in turn suppresses the release of follicle
stimulating hormone (FSH) and luteinizing
hormone (LH) by pituitary gland
 The reduction in FSH and LH affects follicular
development and suppresses ovulation.

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Advantages of LAM
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Universally available to all breastfeeding women.
At least 98% effective
Protection begins immediately postpartum
There are proven health benefits of breastfeeding
for mother and infant.
No commodities or supplies required
LAM can be used temporarily while a
breastfeeding woman decides what other method
of contraception to use.
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Disadvantages of LAM

Full or nearly full breastfeeding may be
difficult for some women to maintain due to
social circumstances
 No STI or HIV protection
 Duration of method is limited
 LAM is a temporary method that can only
be used by breastfeeding women
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Other Contraceptive Options
for Breastfeeding Women

Use of contraceptive methods postpartum is
based on what impact, if any, a method may
have on lactation, breast milk and infant
health.
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Methods that can be started
immediately postpartum:
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Non-hormonal methods
IUDs
Barrier methods
Female sterilization (if there is a medical
indication )
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Methods that can be stared 6
weeks postpartum:
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Progestin-only pills (POPs)
Progestin-only Injectables (DMPA, NETEN)
Subdermal implants ( Norplant )
Hormonal IUS
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Methods that can be started 6
months postpartum:
Methods containing Estrogen
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Combined oral contraceptives (COCs)
Combined monthly injectables
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Other Non-Hormonal Methods
Periodic Abstinence

Periodic abstinence involves abstaining
from intercourse during a woman’s fertile
phase of the menstrual cycle. A woman uses
various signs to identify when she is fertile
and during this time abstains from sexual
intercourse:
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Advantages of periodic
Abstinence
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User-controlled
Readily available
Safe and free from side effects
Requires skills and motivation
Signs of fertility may not be reliable
Requires partner’s cooperation to abstain
No STI/HIV protection
Relatively high failure rates
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Withdrawal

Also known as coitus interrupts, it requires
removing the penis from the vagina before
ejaculation so as to prevent contact between
sperm and the egg.
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Characteristics of Withdrawal

Contraceptive efficacy is similar to that of
barrier methods, with pregnancy rates of
about 4% for perfect use and at least 19%
for typical use during the first year
 Correct and consistent use requires selfcontrol
 Probably provides no protection from
STIs/HIV
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ORAL CONTRACEPTIVES
Types of oral contraceptives (Ocs)
Combined Oral Contraceptives
(COCs)
Progestin-only pills (POPs)
Most widely used
Contain both estrogen and
progestin.
Estrogen content is 0.03 mg or
less
(Note: COCs with higher
estrogen content of 0.050 mg can
be used for emergency
contraception-see pages 39-41 )
Contain no estrogen
The amount of progestin is less
than in COCs
Especially suitable for
breastfeeding women
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Mechanisms Of Action Of Oral
Contraceptives

Suppression of follicle-stimulating hormone
(FSH) and luteinizing hormone (LH) responsible
for follicle development and ovulation (primary
mechanism for COCs, secondary for POPs)
 Thickening of cervical mucus, making it difficult
for sperm to enter the uterine cavity (primary
mechanism for POPs, secondary for POPs)
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Advantages of oral
contraceptives
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Safe and effective: when used correctly and
consistently, pregnancy prevention rate is greater
than 99% (with COCs)
Reversible, rapid return to fertility
No action needed at the time of sexual intercourse
Serious complications are extremely rare
Beneficial health effects other than contraception
Use is controlled by the woman
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Disadvantages of Oral
Contraceptives
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Incorrect use is common not as effective in typed
Require daily use
Side effects are common
May pose health risks for a small number of
women
Re-supply required
Offer no protection against sexually transmitted
infections (STIs), including HIV
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Side Effects of Oral
Contraceptives
Combined Oral Contraceptives
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Nausea
Dizziness
Breast tenderness
Headaches
Mood changes
Weight gain
Breakthrough
bleeding
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Progestin-only Pills
 Irregular bleeding
(when not
breastfeeding)
 Amenorrhea
 Other side effects are
similar to those of
COCs, but less common
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Non-contraceptive Health
Benefits of Oral
Contraceptives
Combined Oral Contraceptives
 Reduced risk of ovarian and

endometrial cancer
 Reduced risk of benign breast
disease
 Reduced risk of ectopic
pregnancy
 Reduced menstrual
irregularities
 Reduced risk of anemia
 Reduced symptoms of painful
menses, dysmenorrhea,
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Progestin-only pills
Thought to have some
of the noncontraceptive health
benefits as in COCs
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Adverse Effects of Oral
Contraceptives
Combined Oral Contraceptives

Increased risk in certain subgroups of
women for cardiovascular complications,
such as thrombosis and stroke
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No overall increase in the risk of breast
cancer among women who have ever used
COCs however, a slightly increased risk of
breast cancer in current users, possibly due
to a detection bias
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Small increase in the risk of cervical cancer,
possibly due to other factors, such as
smoking or multiple sexual partners, or
detection bias
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Progestin-only Pills
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No known adverse effects
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How To Take COCs
Initiating

During the first 7 days of menstrual cycle,
preferable on the first day
 Anytime the provider is reasonably sure
woman is not pregnant
 For non-breastfeeding women postpartumdelay until 3 weeks after childbirth
 For breastfeeding women postpartum-delay
until 6 months after childbirth or until
breastfeeding is discontinued
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Schedule

Take I pill every day until all pills in the
pack are finished
 7- day break between packs (for standard
21-pill packs)
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How to Take POPs
Initiating
Postpartum breastfeeding women – delay 6
weeks
 Postpartum non-breastfeeding women – can
start immediately
 Other women
 Preferably first 5 days of menstrual cycle
 Anytime provider is reasonably sure that
woman is not pregnant
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Schedule

Take I pill each day
 Take within 3 hours of the same time each
day (preferably the same time)
 No break between packs
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Missed Pill Regimen
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Take most recently missed pill as soon as
possible
 If not breastfeeding, abstain from sex or use
backup method for 48 hours
 Take next pll at regular time
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Key counseling Topics for Oral
Contraceptive Users
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Safety and efficacy
How oral contraceptives work
Advantages and disadvantages
Possible side effects and warning symptoms
How to take pills and what to do when pills are
missed
How to obtain and use backup methods and
emergency contraception
No protection from STIs, including HIV
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INJECTABLE CONTRACEPTIVES
Types of Injectable contraceptives
Progestin-only
Injectables
Combined
Injectables
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Product
Duration of protection from
pregnancy
DMPA
(Depot-medroxyprogesterone
acetate)
3 months
NET-EN
(Norethisterone enanthate)
2 months
Mesygyna
50mg DMPA+ 5mg estradiol
valerate
Cyclofem
25mg DMPA+ 5mg estradiol
cypionate
1 month
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Mechanisms of action of
Injectables

Suppression of follicle-stimulating hormone
(FSH) and luteinizing hormone(LH)
responsible for follicle development and
ovulation.
 Thickening of cervical mucus, making it
difficult for sperm to enter the uterine
cavity.
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Advantages of Injectable Contraceptives
Progestin-only Injectables
Cmbined Injectables
 Safe and highly effective (more
than 99%)
 Long-acting, but reversible can be
discontinued without provider’s
help
 Require no effect on action at the
time of intercourse
 Have no effect on lactation and
can be used by breastfeeding
women
 Offer non-contraceptive health
benefits
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 Safe and highly effective
(more than 99%)
 Reversible, can be
discontinued without
provider’s help
 Cause less menstural
disturbances than progestinonly injectables
 Require no action at the time
of intercourse
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Disadvantages of Injectable Contraceptives
Progestin-only Injectables
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Combined Injectables
Side effects are common, specially
menstrual changes in the form of
amenorrhea or irregular bleeding
Contraceptive effect and side effects
cannot be stopped immediately
Return to fertility after discontinuation is
usually delayed. It takes an average of 9
months for a woman to achieve
pregnancy after last injection
No ST/HIV protection
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-
Side effects occur:
Bleeding changes are common, although
less than with progestin-only injectables
- Estrogen-related side effects include
headaches, dizziness and breast
tenderness
 Contraceptive effects and side effects
cannot be stopped immediately
 No ST/HIV protection
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Side Effects Of Injectables

Menstrual changes ( more common for progestin-only
injectables than for combined injectables):
 Irregular bleeding or spotting
 Prolonged or heavy bleeding
 Amenorrhea
 Weight gain (more common for progestin-only injectbles)
 Less common side effects include headaches, dizziness,
breast tenderness and mood changes
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Non-contraceptive Health Benefits of
Progestin-only Injectables
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Reduced risk of:
endometrial cancer and possibly ovarian cancer
ectopic pregnancy
vaginal yeast infection
acute PID
fibroids
Reduced frequency and severity of sickle-cell
disease crises
 Reduced symptoms of endometriosis
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